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Simulering som lärande inom prehospital akutsjukvård
Karlstads universitet, Institutionen för hälsovetenskaper.ORCID iD: 0000-0002-1641-6321
2017 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Simulation as learning in prehospital emergency care (English)
Abstract [sv]

Den prehospitala akutsjukvården är ett komplext kunskapsfält som innebär att vårdaren skall kunna bemöta patient och närstående, bedöma skada, sjukdom och den aktuella situationen samt avgöra vilka vårdåtgärder som skall prioriteras.

Patientens lidande kan lindras genom att vårdaren tränar färdigheter i ett prehospitalt kontext. Detta främjar en god och säker vård samt stärker patientens möjligheter till överlevnad.

Resultatet visar på behovet av simulering inom prehospital akutsjukvård. Med simulering lär sig vårdaren att hantera realistiska, dynamiska och komplexa vårdsituationer, vilket skapar kunskaper, färdigheter och erfarenheter av omhändertagande av patient drabbad av högenergitrauma. Simuleringens utformning och miljö skapar förutsättningar för lärandet vilket framkommer i interventionsstudien.

Utifrån resultatet i föreliggande forskning utvecklas en modell för lärande med hjälp av simulering.

Abstract [en]

The overall aim of the research was to deepen the understanding of learning through simulation in prehospital emergency care.

Method: In this research, qualitative and quantitative methods are used as well as integrative literature studies (I, II). Qualitative data from the interview studies (III, V) were analyzed by phenomenographic methodology. Quantitative data from the intervention study (IV) were analyzed using descriptive and analytical statistics.

Results: Research on simulation and learning within the prehospital trauma care context is relatively rare (I). Simulation of realistic scenarios where the caregivers are exposed to stress contributes to strengthen caregiver knowledge, skills and experience (II). Caregivers request simulation opportunities regarding critical and emergency situations (III). They describe that learning through regular simulation provides in-depth knowledge and skills in the care of a patient exposed to high-energy trauma (V). Interventions with repeated simulation opportunities related to the care of the patient exposed to high-energy trauma give some improvement in care provided at the site of the accident (IV).

Conclusion: Through simulation, the caregivers develop knowledge and skills and receive enhanced confidence in the care of an injured and sick patient. The research suggests several areas with potential for improvement with regard to the care of patients exposed to high-energy trauma. A model has been developed for systematic trauma simulation.

 

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet , 2017. , p. 123
Keywords [en]
simulation, learning, nurse, high-energy trauma, ambulance
Keywords [sv]
simulering, lärande, sjuksköterska, högenergitrauma, ambulans
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:hj:diva-37761ISBN: 978-91-7063-765-0 (print)ISBN: 978-91-7063-766-7 (electronic)OAI: oai:DiVA.org:hj-37761DiVA, id: diva2:1150875
Public defence
2017-05-12, 1A305, Lagerlöfsalen, Universitetsgatan 2, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2017-10-20Bibliographically approved
List of papers
1. Mapping the use of simulation in prehospital care: a literature review.
Open this publication in new window or tab >>Mapping the use of simulation in prehospital care: a literature review.
2014 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, no 22, p. 12-Article in journal (Refereed) Published
Abstract [en]

Background:

High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice.

Methods:

An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context.

Results:

The volume of published research is distributed between 1984-2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage.

Conclusion:

Simulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staff regarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack of knowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training and research, at both local and global levels.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Simulation, Prehospital, Systematic literature review
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:hj:diva-37693 (URN)10.1186/1757-7241-22-22 (DOI)000334795700001 ()24678868 (PubMedID)
Available from: 2014-09-15 Created: 2017-10-20 Last updated: 2017-11-29Bibliographically approved
2. Learning by simulation in prehospital emergency care: an integrative literature review
Open this publication in new window or tab >>Learning by simulation in prehospital emergency care: an integrative literature review
2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 2, p. 234-240Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Acquiring knowledge and experience on high-energy trauma is often difficult due to infrequent exposure. This creates a need for training which is specifically tailored for complex prehospital conditions. Simulation provides an opportunity for ambulance nurses to focus on the actual problems in clinical practice and to develop knowledge regarding trauma care. The aim of this study was to describe what ambulance nurses and paramedics in prehospital emergency care perceive as important for learning when participating in simulation exercises.

METHODS: An integrative literature review was carried out. Criteria for inclusion were primary qualitative and quantitative studies, where research participants were ambulance nurses or paramedics, working within prehospital care settings, and where the research interventions involved simulation.

RESULTS: It was perceived important for the ambulance nurses' learning that scenarios were advanced and possible to simulate repeatedly. The repetitions contributed to increase the level of experience, which in turn improved the patients care. Moreover, realism in the simulation and being able to interact and communicate with the patient were perceived as important aspects, as was debriefing, which enabled the enhancement of knowledge and skills. The result is presented in the following categories: To gain experience, To gain practice and To be strengthened by others.

CONCLUSION: Learning through simulation does not require years of exposure to accident scenes. The simulated learning is enhanced by realistic, stressful scenarios where ambulance nurses interact with the patients. In this study, being able to communicate with the patient was highlighted as a positive contribution to learning. However, this has seldom been mentioned in a previous research on simulation. Debriefing is important for learning as it enables scrutiny of one's actions and thereby the possibility to improve and adjust one's caring. The effect of simulation exercises is important on patient outcome.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
accident and emergency; acute care; advanced nursing practice; clinical nurse specialist; emergency; paramedical care
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:hj:diva-37692 (URN)10.1111/scs.12252 (DOI)000383802300003 ()26333061 (PubMedID)
Available from: 2015-12-04 Created: 2017-10-20 Last updated: 2017-10-20Bibliographically approved
3. The prehospital assessment of severe trauma patients’ by specialist ambulance nurse in Sweden-a phenomenographic study
Open this publication in new window or tab >>The prehospital assessment of severe trauma patients’ by specialist ambulance nurse in Sweden-a phenomenographic study
2012 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, p. 67-Article in journal (Refereed) Published
Abstract [en]

Background

A common feature of prehospital emergency care is the short and fragmentary patient encounters with increased demands for efficient and rapid treatment. Crucial decisions are often made and the premise is the specialist ambulance nurse’s ability to capture the situation instantaneously. The assessment is therefore a pre-requisite for decisions about appropriate actions. However, the low exposure to severe trauma cases in Sweden leads to vulnerability for the specialist ambulance nurse, which makes the assessment more difficult. Our objective was to describe specialist ambulance nurses’ perceptions of assessing patients exposed to severe trauma.

Methods

This study had a phenomenographic approach and was performed in 2011 as an interview study. 15 specialist ambulance nurses with a minimum of 2.5 years of experience from praxis were included. The analysis of data was performed using phenomenography according to Marton.

Results

The perceptions of assessing patients exposed to severe trauma were divided into: To be prepared for emergency situations, Confidence in one’s own leadership and Developing professional knowledge.

Conclusions

This study reveals that the specialist ambulance nurse, on the scene of accident, finds the task of assessment of severe trauma patients difficult and complicated. In some cases, even exceeding what they feel competent to accomplish. The specialist ambulance nurses feel that no trauma scenarios are alike and that more practical skills, more training, exercise and feedback are needed.

Place, publisher, year, edition, pages
BioMed Central, 2012
Keywords
Specialist ambulance nurse; Assessment; Prehospital care; Severe trauma; Phenomenography
National Category
Medical and Health Sciences
Research subject
Nursing Science
Identifiers
urn:nbn:se:hj:diva-37690 (URN)10.1186/1757-7241-20-67 (DOI)000312636000001 ()22985478 (PubMedID)
Available from: 2013-06-05 Created: 2017-10-20 Last updated: 2017-11-29Bibliographically approved
4. Effect of repeated simulation on the quality of trauma care
Open this publication in new window or tab >>Effect of repeated simulation on the quality of trauma care
2017 (English)In: Clinical Simulation in Nursing, ISSN 1876-1399, E-ISSN 1876-1402, Vol. 13, no 12, p. 601-608Article in journal (Refereed) Published
Abstract [en]

Background

Simulation participants are not dependent on learning during an actual clinical situation. This allows for a learning environment that can be constructed to meet the knowledge and experience needs of the participant. Simulations in a prehospital emergency are an ideal way to address these needs without risking patient safety.

Method

Nurses in prehospital emergency care (n = 63) participated in simulation interventions. During the simulation, the performed trauma care was assessed in two groups of participants with different frequency of simulation.

Results

Several statistically significant differences and clinical improvements were found within and between the groups. Differences were noted in specific assessments, examinations, care actions, and time from assessment to action.

Conclusion

The result suggested that repeated simulation may contribute to a clinical improvement in trauma care, and more frequent simulation may led to even greater improvements.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
simulation; learning; experience; ambulance; prehospital emergency care; trauma
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:hj:diva-37736 (URN)10.1016/j.ecns.2017.07.006 (DOI)000415717300002 ()2-s2.0-85033574388 (Scopus ID)
Note

Included in thesis in submitted form.

Available from: 2017-04-21 Created: 2017-10-20 Last updated: 2018-01-19Bibliographically approved
5. Simulation of high-energy trauma makes knowledge readily available from memory
Open this publication in new window or tab >>Simulation of high-energy trauma makes knowledge readily available from memory
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:hj:diva-37737 (URN)
Available from: 2017-04-21 Created: 2017-10-20 Last updated: 2017-10-20

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